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Phone: 920.729.7105 Fax: 920.720.2150 www.womenscareofwi.comAUTHORIZATION FOR DISCLOSURE OF HEALTH INFORMATION TO WOMEN\'S CARE OF WISCONSIN 1.2.PATIENT: ___Name of Patient/Previous Names___ Birth
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Step 1: Obtain the WCOW medical records release form.
02
Step 2: Read the instructions provided on the form carefully.
03
Step 3: Fill in your personal information accurately, including your name, address, and contact details.
04
Step 4: Specify the medical records you want to release by providing relevant details such as the name of the healthcare provider or facility.
05
Step 5: Sign and date the form to certify that the information is accurate and that you authorize the release of your medical records.
06
Step 6: Submit the completed form to the appropriate recipient, which may be a healthcare provider, insurance company, or legal representative.

Who needs wcow medical records release?

01
Patients who require their WCOW medical records to be shared with other healthcare providers for continuity of care.
02
Individuals who need to provide their medical records to insurance companies for claims processing.
03
Legal professionals who may require access to a patient's medical records for legal proceedings.
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WCOW medical records release is a legal document that authorizes the transfer of a patient's medical records from one healthcare provider to another or to a third party.
Typically, the patient or their legal representative is required to file the WCOW medical records release in order to share or access medical records.
To fill out a WCOW medical records release, the individual must provide necessary personal information, specify which records are being requested, indicate the purpose of the request, and sign the form to authorize the release.
The purpose of the WCOW medical records release is to ensure that patients can manage their own health information and share it with other medical professionals as necessary for their care.
The WCOW medical records release must include the patient's name, date of birth, the specific records being requested, the name of the healthcare provider releasing the records, and the patient's signature.
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